A case-control study comprising 1315 Campylobacter jejuni cases, 121 Campylobacter coli cases and 3409 frequency-matched controls was conducted in The Netherlands in 2002–2003. Risk factors for both C. jejuni and C. coli enteritis were consumption of undercooked meat and barbecued meat, ownership of cats and use of proton pump inhibitors. Consumption of chicken was a predominant risk factor for C. jejuni enteritis, but many additional risk factors were identified. Unique risk factors for C. coli infections were consumption of game and tripe, and swimming. Contact with farm animals and persons with gastroenteritis were predominant risk factors for C. jejuni enteritis in young children (0–4 years). Important risk factors for the elderly (⩾60 years) were eating in a restaurant, use of proton pump inhibitors and having a chronic intestinal illness. Consumption of chicken in spring, steak tartare in autumn and winter and barbecued meat in rural areas showed strong associations with C. jejuni infections. This study illustrates that important differences in risk factors exist for different Campylobacter spp. and these may differ dependent on age, season or degree of urbanization.

Four types of observations have been used to illustrate the seasonal characteristics of epidemic influenza: (1) The experience of a small population during 28 consecutive years, 1946–74, (2) world influenza outbreaks 1964–75 reported to the World Health Organization, (3) the experience of two widely separated localities at about the same latitude, 1969–74, and (4) the experience of two places at latitudes 30° + on opposite sides of the Equator, 1968–74.

The following tendencies are shown. (1) Outbreaks of influenza even in the small community came at approximately the same season almost every year. (2) Outbreaks are globally ubiquitous and epidemic loci move smoothly to and fro across the surface of the earth almost every year in a sinuous curve that runs parallel with the ‘midsummer’ curve of vertical solar radiation, but lags about six months behind it. Such findings exclude the mediation of seasonal control by any agencies of local distribution, and suggest a direct effect of variations in some component of solar radiation on virus or human host. (3) Antigenic variations in influenza A virus tended to have the same seasonal characteristics as epidemicity. This suggests that epidemicity and virus variation are two facets of one seasonally controlled process.

None of these seasonal characteristics can be explained by the current concept of influenzal epidemiology. A new hypothesis recently proposed and recapitulated in the Appendix offers a possible explanation. The primary agency mediating seasonal control remains unidentified.

An outbreak of 24 cases of hepatitis A in Aberdeen was traced to a large hotel in the city by epidemiological investigation. Food-specific questioning of those affected, their fellow diners and hotel staff, coupled with serological studies, implicated raspberry mousse prepared from frozen raspberries as the source of the infection. The raspberries were probably contaminated at the time of picking.

This study was designed to determine the prevalence of Escherichia coli O157:H7 infection of beef calves at weaning, prior to arrival at the feedlot or mixing with cattle from other sources. Fifteen range cow-calf herds, which weaned calves in October and November, were sampled in Kansas, Missouri, Montana, Nebraska and South Dakota. Faecal culture for E. coli O157:H7 was performed and anti-O157 serum antibody titres were determined by blocking ELISA. Thirteen of the 15 herds (87%) were found to have at least one positive isolation of E. coli O157:H7 in faecal samples. Within positive herds, prevalence ranged from 1·7–20·0%, with an average of 7·4±6·2% s.d. of individual animals shedding E. coli O157:H7 in faeces. All herds had high prevalence of anti-O157 antibodies, ranging 63–100% of individuals within herds seropositive. This study indicates that E. coli O157:H7 infection before weaning, prior to entry into feedlots, is widespread. Furthermore, serologic evidence suggests that most calves (83%) and all herds (100%) have been exposed to E. coli O157.

Two epidemics of water-borne diarrhoeal disease involving a total of 1000 persons are reported. In both epidemics, none of the usual bacterial enteropathogens were recognized and Plesiomonas shigelloides was the only suspect aetiological agent isolated. The ecology of P. shigelloides was investigated in these outbreaks. It was recognized as an inhabitant of fresh surface water and its presence was closely related to warm weather.

This paper uses meta-analysis of published data and a deterministic mathematical model of hepatitis B virus (HBV) transmission to describe the patterns of HBV infection in high endemicity areas. We describe the association between the prevalence of carriers and a simple measure of the rate of infection, the age at which half the population have been infected (A50), and assess the contribution of horizontal and perinatal transmission to this association. We found that the two main hyper-endemic areas of sub-Saharan Africa and east Asia have similar prevalences of carriers and values of A50, and that there is a negative nonlinear relationship between A50 and the prevalence of carriers in high endemicity areas (Spearman's Rank, P = 0·0086). We quantified the risk of perinatal transmission and the age-dependent rate of infection to allow a comparison between the main hyper-endemic areas. East Asia was found to have higher prevalences of HBeAg positive mothers and a greater risk of perinatal transmission from HBeAg positive mothers than sub-Saharan Africa, though the differences were not statistically significant. However, the two areas have similar magnitudes and age-dependent rates of horizontal transmission. Results of a simple compartmental model suggest that similar rates of horizontal transmission are sufficient to generate the similar patterns between A50 and the prevalences of carriers. Interrupting horizontal transmission by mass immunization is expected to have a significant, nonlinear impact on the rate of acquisition of new carriers.

A summer outbreak of severe gastroenteritis followed by haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura in a nursery school and kindergarten is described. Sandwiches prepared with green butter made with contaminated parsley were the likely vehicle of infection. The parsley originated from an organic garden in which manure of pig origin was used instead of artificial fertilizers, Cornally identical Verotoxinogenic Citrobacter freundii were found as causative agents of HUS and gastroenteritis and were also detected on the parsley.

From April 1998 to March 2000, 18 broiler flocks were followed from the hatchery to the slaughterhouse. Campylobacter was not found in the hatchery, 1-day-old chicks or in the rearing house before the arrival of the chicks. The infection of broiler flocks increased continuously during the rearing time, with a total of seven positive flocks at the end of rearing. Farms with Campylobacter-positive broilers were characterized by the circulation of Campylobacter in the environment (puddles, dung hill) and on the footwear of the farmer. The administration of antibiotics did not significantly reduce Campylobacter shedding. With the exception of one flock during rearing and a few flocks in the slaughterhouse with a mixed Campylobacter coli–Campylobacter jejuni infection, C. jejuni exclusively was found both during rearing and on the carcasses. A significant correlation exits between the contamination of the broilers during rearing and the carcasses after processing. No slaughterhouse was able to avoid contamination of carcasses when status-positive animals were delivered. Moreover, six negatively delivered flocks yielded positive carcasses, the result of a supplementary contamination, which occurred during transport and slaughtering.

From 1996 to 2003, four 12-month population-based surveys were performed in FoodNet sites to determine the burden of diarrhoeal disease in the population. Acute diarrhoeal illness (ADI) was defined as [ges ]3 loose stools in 24 hours with impairment of daily activities or duration of diarrhoea >1 day. A total of 52840 interviews were completed. The overall weighted prevalence of ADI in the previous month was 5·1% (95% CI±0·3%), corresponding to 0·6 episodes of ADI per person per year. The average monthly prevalence of ADI was similar in each of the four survey cycles (range 4·5–5·2%). Rates of ADI were highest in those age <5 years. Of those with ADI, 33·8% (95% CI±2·7%) reported vomiting, 19·5% (95% CI±2·1%) visited a medical provider, and 7·8% (95% CI±1·4%) took antibiotics. Rates of ADI were remarkably consistent over time, and demonstrate the substantial burden placed on the health-care system.

Although food handlers are often implicated as the source of infection in outbreaks of food-borne viral gastroenteritis, little is known about the timing of infectivity in relation to illness. We investigated a gastroenteritis outbreak among employees of a manufacturing company and found an association (RR=14·1, 95% CI=2·0–97·3) between disease and eating sandwiches prepared by 6 food handlers, 1 of whom reported gastroenteritis which had subsided 4 days earlier. Norwalk-like viruses were detected by electron microscopy or reverse transcriptase-polymerase chain reaction (RT-PCR) in stool specimens from several company employees, the sick food handler whose specimen was obtained 10 days after resolution of illness, and an asymptomatic food handler. All RT-PCR product sequences were identical, suggesting a common source of infection. These data support observations from recent volunteer studies that current recommendations to exclude food handlers from work for 48–72 h after recovery from illness may not always prevent transmission of Norwalk-like viruses because virus can be shed up to 10 days after illness or while exhibiting no symptoms.

Between 1 August and 15 September 2000, 361 cases of Salmonella enterica serotype Typhimurium definitive phage type (DT) 104, resistant to ampicillin, chloramphenicol, streptomycin, sulphonamides, spectinomycin and tetracycline (R-type ACSSuSpT), were identified in England and Wales residents. Molecular typing of 258 isolates of S. Typhimurium DT104 R-type ACSSuSpT showed that, although isolates were indistinguishable by pulsed-field gel electrophoresis, 67% (174/258) were characterized by a particular plasmid profile. A statistically significant association between illness and consumption of lettuce away from home was demonstrated (OR=7·28; 95% CI=2·25–23·57; P=0·0006) in an unmatched case–control study. Environmental investigations revealed that a number of food outlets implicated in the outbreak had common suppliers of salad vegetables. No implicated foods were available for microbiological testing. An environmental audit of three farms that might have supplied salad vegetables to the implicated outlets did not reveal any unsafe agricultural practices. The complexity of the food supply chain and the lack of identifying markers on salad stuffs made tracking salad vegetables back to their origin extremely difficult in most instances. This has implications for public health since food hazard warnings and product withdrawal are contingent on accurate identification of the suspect product.

We reviewed the epidemiological and microbiological characteristics of 89 reported outbreaks of waterborne infectious intestinal disease affecting 4321 people in England and Wales over the period 1992–2003. Public water supplies were implicated in 24 outbreaks (27%), private water supplies in 25 (28%), swimming pools in 35 (39%) and other sources in five outbreaks (6%). Cryptosporidium was implicated in 69% of outbreaks, Campylobacter sp. in 14%, Giardia in 2%, E. coli O157 in 3% and Astrovirus in 1%. From 2000, there was a consistent decline in the number of outbreaks of waterborne disease associated with public water supplies. The incidence rate of outbreaks in recipients of private water supplies may be as high as 35 times the rate in those receiving public water supplies (1830 vs. 53 per million population). Private water suppliers need to be aware of the importance of adequate treatment and the prevention of faecal contamination of storage water. Swimming-pool operators need to ensure chlorination and in particular adequate filtration measures are in place.

Cattle infected with FMDV strains of different epizootiological origin developed a carrier state which persisted in the majority of animals for several months. Fluid samples taken from the oesophageal/pharyngeal region were assayed for infectivity by plaque counts on BHK monolayer cultures and by mouse inoculation. With one strain of virus, infectivity levels of up to 1000 pfu/ml. were recorded for several weeks after infection but in general the virus content of samples was below 50 pfu/ml.

The sites of virus persistence and multiplication were identified by titration of suspensions of mucosae and epithelia taken post mortem. Virus was recovered from 41 of 54 cattle killed 14–196 days after infection. The chief sites of virus multiplication based on the frequency of virus recovery and infectivity titres were the dorsal surface of the soft palate and the pharynx. Virus was recovered less frequently from the ventral surface of the soft palate and the glosso-epiglottic space and only occasionally from the tonsillar sinuses, tonsils, tongue, trachea and oesophagus. No virus was detected in the turbinates or in the epithelium of the urinary bladder.

1. A good immunity was produced in chickens against oral infection with Salm. gallinarum by the use of either of two live attenuated vaccines, one smooth, 9S and one rough, 9R. Dead vaccines had little or no effect.

2. The immunity possessed by chickens vaccinated with 9R at 7 weeks of age commenced to wane 12 weeks later. Chickens similarly vaccinated with 9S were completely immune 4, 12 and 34 weeks later. When tested during the active laying period (at 20 weeks after vaccination) their immunity, although substantial, was not complete.

3. Vaccine 9R did not produce demonstrable agglutinins against smooth Salm. gallinarum in chickens. It was non-lethal to 1-day-old chicks and was never found to revert to the smooth virulent form in vitro or in vivo. By contrast, vaccine 9S produced agglutinins and was lethal for 1-day-old chicks, its virulence not being increased by passage. No deaths were ever observed when this vaccine was used in either chickens of 5–12 weeks old or laying hens.

4. Although both vaccines produced a good immunity when employed in laying hens, vaccination with 9S was accompanied by a marked reduction in egg production; this was not the case with 9R.

5. An immunity of the interference type was also evoked by both live vaccines. This immunity was still produced to some extent in chickens injected with 9S, 2 days after they were infected with Salm. gallinarum by mouth.

6. The interference effect could not be produced by the use of either dead Salm. gallinarum vaccines or certain non-specific substances. The intravenous injection of indian ink had a marked adverse effect on the course of the disease. Injecting chickens with a virulent strain of Bacterium coli at the same time as they were infected with Salm. gallinarum resulted in the latter infection running a milder course than would normally have been expected.

Campylobacter is a common but decreasing cause of foodborne infections in the USA. Outbreaks are uncommon and have historically differed from sporadic cases in seasonality and contamination source. We reviewed reported outbreaks of campylobacteriosis. From 1997 to 2008, 262 outbreaks were reported, with 9135 illnesses, 159 hospitalizations, and three deaths. The annual mean was 16 outbreaks for 1997–2002, and 28 outbreaks for 2003–2008. Almost half occurred in warmer months. Foodborne transmission was reported in 225 (86%) outbreaks, water in 24 (9%), and animal contact in seven (3%). Dairy products were implicated in 65 (29%) foodborne outbreaks, poultry in 25 (11%), and produce in 12 (5%). Reported outbreaks increased during a period of declining overall incidence, and seasonality of outbreaks resembled that of sporadic infections. Unlike sporadic illnesses, which are primarily attributed to poultry, dairy products are the most common vehicle identified for outbreaks.

The modification of Middlebrook's 7H11 oleic acid albumin agar medium by the addition of fresh bovine serum and lysed sheep red cells to encourage growth of Mycobacterium bovis is described. The improved medium was made selective by the addition of antibiotics and a comparative trial of this medium and the guineapig test in the isolation of M. bovis from badger tissues is reported. A close agreement between the two tests was found; the guinea-pig test detected 95% of all isolations and culture detected 91%.

Values are given for the median equivalent diameters and for the inter-quartile range, of airborne particles carrying a variety of micro-organisms.

Organisms associated with human disease or carriage were usually found on particles in the range 4–20 μ equivalent diameter.

Many fungi appeared to be present in the air as single spores.

We should like to acknowledge the collaboration of Dr Yvonne M. Clayton in the collection and examination of the fungal samples.

During the period 1981–8 a clinical trial of a Q fever vaccine (Q-vax; Commonwealth Serum Laboratories, Melbourne) has been conducted in abattoir workers and other at-risk groups in South Australia. Volunteers in four abattoirs and visitors to the abattoirs were given one subcutaneous dose of 30 μg of a formalin-inactivated, highly-purified Coxiella burnetii cells, Henzerling strain, Phase 1 antigenic state, in a volume of 0·5 ml.

During the period, over 4000 subjects have been vaccinated and the programme continues in the abattoirs and related groups. ‘Common’ reactions to the vaccine comprised tenderness and erythema, rarely oedema at the inoculation site and sometimes transient headache. Two more serious ‘uncommon’ reactions, immune abscess at the inoculation site, were observed in two subjects, and two others developed small subcutaneous lumps which gradually dispersed without intervention.

Protective efficacy of the vaccine appeared to be absolute and to last for 5 years at least. Eight Q fever cases were observed in vaccinees, but all were in persons vaccinated during the incubation period of a natural attack of Q fever before vaccine-induced immunity had had time (≥ 13 days after vaccination) to develop. On the other hand, 97 Q fever cases were detected in persons working in, or visiting the same abattoir environments.

Assays for antibody and cellular immunity showed an 80–82% seroconversion after vaccination, mostly IgM antibody to Phase 2 antigen, in the 3 months after vaccination. This fell to about 60%, mostly IgG antibody to Phase 1 antigen, after 20 months. On the other hand, 85–95% of vaccinees developed markers of cell mediated immunity as judged by lymphoproliferative responses with C. burnetii antigens; these rates remained elevated for at least 5 years.

The Q fever vaccine, unlike other killed rickettsial vaccines, has the property of stimulating long-lasting T lymphocyte memory and this may account for its unusual protective efficacy as a killed vaccine.

In January 1999, an outbreak of viral gastroenteritis affected more than 300 people who attended a metropolitan concert hall over a 5-day period. Norwalk-like virus (NLV) was confirmed in faecal samples by reverse transcription polymerase chain reaction assay. The index case was a concert attendee who vomited in the auditorium and adjacent male toilet. Gastrointestinal illness occurred among members of 8/15 school parties who attended the following day. Children who sat on the same level of the auditorium as the index case were much more likely to be ill than those seated elsewhere (relative risk 7.1, 95% confidence interval 5.4–9.2, P<0.001). The majority of other reported cases had not been present on the evening of the vomiting incident. Disinfection procedure was poor and the disinfectant used contained no sodium hypochlorite. Transmission most likely occurred through direct contact with contaminated fomites. The outbreak has implications for disinfection procedures following vomiting incidents at public venues.

Salmonellosis is a global problem caused by the international movement of foods and high incidence in exporting countries. In September 2001, in an outbreak investigation Australia isolated Salmonella Stanley from imported peanuts, which resulted in a wider investigation in Canada, England & Wales and Scotland. Patients infected with Salmonella serotypes known to be isolated from peanuts and reported to surveillance systems were interviewed to determine exposure histories. Tagged image file format (TIFF) images of pulsed-field gel electrophoresis (PFGE) patterns of Salmonella isolates were shared electronically amongst laboratories. Laboratories tested packets of ‘Brand X’ peanuts from various lots and product lines. In total, 97 cases of S. Stanley and 12 cases of S. Newport infection were found. Seventy-three per cent (71/97) of S. Stanley cases were in persons of Asian ethnicity. Twenty-eight per cent of cases recalled eating Brand X peanuts and a further 13% had peanuts in their house in the previous month or had eaten Asian-style peanuts. Laboratories isolated S. Stanley, S. Newport, S. Kottbus, S. Lexington and S. Unnamed from Brand X peanuts. Isolates of S. Stanley from peanuts and human patients were indistinguishable by PFGE. This international outbreak resulted from a product originating from one country affecting several others. Rapid sharing of electronic DNA images was a crucial factor in delineating the outbreak; multinational investigations would benefit from a harmonized approach.